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Stroke: Minutes can save lives

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Dr Vipul Gupta
Doctors at Artemis Agrim Institute of Neurosciences perform advanced treatment of mechanical thrombectomy to save the life of a 71-year-old female suffering from a severe stroke. The timely intervention not only saved her life but the patient had recovered completely and joined back to her work within a week.
The patient who herself is a doctor’s mother developed sudden weakness on the left side of the body, and with awareness that this might be a stroke, she and her family were swift to rush to a local hospital. Detailed investigations revealed a stroke in the right side of the brain occluded by a large blood clot in the right-side artery to the brain, which resulted in complete lack of blood flow in the right side of the brain.
While the patient’s family was already in touch with the stroke intervention team at Artemis Agrim Hospital, a clot dissolving drug in the brain (tPA) was administered at the local hospital to open up the blood vessel until the patient is cautiously transferred to Artemis Agrim Institute of Neurosciences for neurointerventional procedure known as “mechanical thrombectomy.
Though clot dissolving drugs are highly effective for small occlusions, but in this case with large occlusion, the effectiveness was very low and required immediate intervention.
The stroke intervention team were ready in the emergency to shift the patient quickly into the neuro interventional Cath lab where the endovascular procedure thrombectomy was done to open up the blood vessel. In this procedure, through the leg blood vessel a thin tube was taken into the brain into the area of the clot which was and a device known as stent retriever was deployed in the clot and it was taken out of the body. This resulted in complete restoration of the flow to the brain. The procedure was done with in 30 minutes of arrival of patient and she made a complete recovery and could go back to work within a week of the stroke.
When it comes to stroke, every minute matters. During each minute 2 million cells die. In a way during stroke the patient keep losing a part of oneself with each passing minute. Nowadays we have modern methods of treating stroke in which very early treatment can stop the stroke in its tracks and can even reverse it. However, to be effective one has to do treat in first few golden hours after stroke.
The blockage of brain blood vessels can be opened by giving intravenous injection of a clot dissolving drug (tPA) in first 4.5 hours. When there is a large blood clot or patient is beyond the limit of the tPA, then doctors can do interventional procedure known as mechanical thrombectomy to reopen the blood vessel. By restoring the blood supply these procedures can revive the brain cells and restore the function of the brain. However, these methods are effective if the patient reaches in first few hours of stroke known as golden hours. Mechanical thrombectomy is very effective in opening blood vessels, but patients’ recovery depends upon how early it is done after the stroke.
Time is brain’ and it is most important for the patients to recognise the onset of stroke, which requires awareness about its symptoms. People need to remember the acronym FAST which expands as – F means face drooping on side, A means Unable to lift one of the arms, S means the patient is unable to speak properly and T stands for the importance of time, where patient should be rushed to a hospital with a stroke unit.
He explained that in the Stroke Unit a team of doctors including neurointervention team is available round the clock. For fast treatment, teams of emergency physicians, stroke physicians, neurointerventional and neurocritical care team co-ordinate to perform emergency treatment within the first few golden hours of stroke. Dr Vipul Gupta said that the team monitors and review the time taken for emergency treatment so that regular improvement can be done.
(The author is Chief of Neurointervention and Co-director of Stroke Unit at Artemis-Agrim Institute of Neurosciences)


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